19 July 2013

Bell's Palsy treatment not being consistently applied, says study

Clinical treatment of the disfiguring condition Bell's Palsy - which affects around 1 in 60 people in their lifetime - is not consistently following the latest recommendations from research trials, a study led by the University of Dundee has found.

The study, published in the online version of the British Medical Journal, also shows that hospital referrals for Bell's Palsy are falling, suggesting more patients are being dealt with at the primary care level.

Bell's Palsy is a condition that paralyses half of the face. Sufferers are affected by a sudden paralysis, characterised by the swelling of a nerve in the face.

High-profile sufferers of the condition have included George Clooney and Pierce Brosnan.

The condition affects around 1 in 60 people during their lifetime, or around 100 people per month in Scotland. It can strike almost anyone at any age but disproportionately affects pregnant women and sufferers of diabetes, flu, colds and other upper respiratory ailments.

For around one in 20 sufferers there is no significant recovery at all, although in almost three-quarters of cases there is complete recovery within 3 to 6 weeks.

In 2007, a research team led by Professor Frank Sullivan at the University of Dundee published a paper in the New England Journal of Medicine which showed that early treatment with the steroid prednisolone offered a substantial increase in complete recovery rates, compared to treatment with anti-viral drugs.

The researchers found that treatment with prednisolone offered a 95% rate of complete recovery after nine months. 83% showed complete recovery at three months of treatment.

'Our 2007 study showed that prednisolone presented a significant improvement in how we treat Bell's Palsy and could make a real difference to patients,' said Professor Sullivan, Director of the Scottish School of Primary Care at the University of Dundee.

'We have now carried out a follow-up study to measure the impact of that research in how Bell's Palsy is being treated. What we can see is that treatment with prednisolone did increase following our 2007 study but has plateaued in the past three years while there has been little change in the use of the less-effective antiviral treatments.

'This indicates that management and treatment of Bell's Palsy did change following 2007 but not to the extent that would indicate the results of the study have been wholly taken on by clinicians.

'The reasons for this are unexplained but it does suggest that better ways are needed to understand and circumvent barriers in implementing clinical trial findings if we are to ensure that patients fully benefit from research.'

The new study also showed that referrals of Bell's Palsy patients to hospital were falling. Dr Daniel Morales, who led this follow up study, said this was a positive sign that more was being done at the primary care level, thus reducing the burden on hospitals.

The new study has been published in the online version of the British Medical Journal (BMJ open). The paper is available to view at: bmjopen.bmj.com/content/3/7/e003121.full.

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